End-Tidal CO2

In this podcast episode, Dr. Rishi, a cardiothoracic anesthesiologist and critical care physician, delves into the intricacies of end-tidal capnography. He emphasizes its versatile applications in resuscitation, spanning the operating room, ICU, and emergency department. Dr. Rishi breaks down the fundamental concepts of end-tidal capnography, exploring its relevance in procedural sedation, mechanical ventilation, and confirmation of endotracheal tube placement. He provides insights into the two typical measurement methods: sidestream and mainstream capnography, highlighting their respective advantages and limitations. The discussion extends to interpreting capnograms, with Dr. Rishi detailing the phases and nuances, including their significance in various clinical scenarios such as trauma, cardiac arrest, and fluid responsiveness. Furthermore, he touches on how end-tidal capnography can offer valuable information in assessing right ventricular function, traumatic brain injury, acidemia, and even post-cardiopulmonary bypass situations. Dr. Rishi concludes by shedding light on potential challenges and abnormalities in capnograms, offering a comprehensive overview of this vital tool in clinical practice.

Key Takeaways:

1. Versatile Applications: End-tidal capnography finds utility in various clinical settings, from the operating room and ICU to the emergency department, providing valuable insights into procedural sedation, ventilation, and airway management.
2. Measurement Methods: Two common ways to measure end-tidal CO2 are sidestream and mainstream capnography, each with its advantages and limitations. Sidestream is versatile but prone to kinking, while mainstream provides continuous and reflective data but introduces dead space.
3. Interpreting Capnograms: Understanding the phases of a capnogram is crucial, with Dr. Rishi elaborating on the nuances of the baseline, upslope, plateau, and end-tidal CO2 phases. This interpretation aids in clinical decision-making.
4. Clinical Applications: End-tidal capnography serves as a gold standard in scenarios like confirming endotracheal tube placement, assessing the quality of chest compressions during cardiac arrest, and predicting fluid responsiveness in certain patient populations.
5. Challenges and Abnormalities: Dr. Rishi highlights potential challenges and abnormalities in capnograms, such as obstructions, changes in patient position, and variations related to specific medical conditions. Recognizing these nuances is crucial for accurate clinical interpretation.